Endo p. 322-326

Question 1

Name the T3 functions—4 B’s:

Answer 1

Brain maturation
Bone growth
β-adrenergic effects
Basal metabolic rate 

Question 2

When are the levels of TBG decr?

Answer 2

in hepatic failure, steroids usage

Question 3

How does T3/T4 change the basal metabolic rate?

Answer 3

via  Na+/K+-ATPase activity Ž–> incr O2 consumption, RR, body temperature


Question 4

Which adrenaline receptors in the heart does T4/T3 affect?

Answer 4

incr β1 receptors in heart =  incr CO, HR, SV,

contractility

Question 5

What effect does T3/T4 have on glycogen and lipids?

Answer 5

incr glycogenolysis, gluconeogenesis, lipolysis

Question 6

 When are the TBG leves incr?

Answer 6

in pregnancy or OCP use (estrogen incr TBG).

Question 7

T or F? Propylthiouracil inhibits only peroxidase.

Answer 7

F. inhibits both peroxidase and 5’-deiodinase

Question 8

Explain the Wolff-Chaikoff effect:

Answer 8

excess iodine temporarily inhibits thyroid peroxidase–>

Ž decr iodine organification–> decr T3/T4 production.

Question 9

T3 binds — receptor with —- affinity than T4.

Answer 9

nuclear

greater

Question 10

Methimazole inhibits —.

Answer 10

peroxidase

Question 11

coupling of monoiodotyrosine and di-iodotyrosine happens via which enzyme?

Answer 11

peroxidase

Question 12

T4 is converted to T3 in peripheral tissue by which enzyme?

Answer 12

5’deiodinase

Question 13

Which Anions inhibit iodine oxidation?

Answer 13

perchlorate, pertechnetate, thiocyanate, iodide

Question 14

High-dose dexamethasone suppression test causes what in Cushings dx?

Answer 14

free cortisol suppression

Question 15

How many mg is administred during High-dose dexamethasone test?

Answer 15

8mg - high dose

Question 16

Name 3 cause for incr in cortisol?

Answer 16

• Exogenous corticosteroids
• Primary adrenal adenoma, hyperplasia, or carcinoma
• ACTH-secreting pituitary adenoma, paraneoplastic ACTH

Question 17

Difference between Cushing syndrome and Cushing disease?

Answer 17

ACTH-secreting pituitary adenoma - C. disease

incr Cortisol from variety of conditions - C. syndrome

Question 18

2 path causing Cushing syndrome?

Answer 18

small cell lung cancer, bronchial carcinoids

Question 19

Is adrenal tumor an ACTH-independent or dependent Cushing syndrome?

Answer 19

ACTH-independent Cushing syndrome

Question 20

Is ectopic ACTH secretion an ACTH-independent or dependent Cushing syndrome?

Answer 20

ACTH-dependent

Question 21

CRH stimulation test helps diagnose which pathology?

Answer 21

Cushing disease (incr ACTH) vs 
ectopic ACTH secretion (no incr of ACTH)

Question 22

What an alternative test used to dx adrenal insufficiency?

Answer 22

Metyrapone stimulation test

Question 23

metyrapone blocks which process?

Answer 23

11-deoxycortisol –> Ž cortisol

Question 24

Pt presents w/ sudden onset of massive

hemorrhage and shock. What is the adrenal path?

Answer 24

Primary Acute adrenal insufficiency or Waterhouse-Friderichsen syndrome

Question 25

Competitive athlete on school break shows signs of adrenal insufficiency, which type is his pathology?

Answer 25

Tertiary: chronic exogenous precipitated by abrupt withdrawal.

Question 26

skin and mucosal hyperpigmentation is seen in which type of adrenal insuff.? and why?

Answer 26

Primary

Question 27

TB can cause what kind of Adrenal insuff.?

Answer 27

Chronic—aka Addison disease. Due to

adrenal atrophy or destruction by disease

Question 28

— is a byproduct of  ACTH production from —-.

Answer 28

MSH

pro-opiomelanocortin

Question 29

In which type of Adrenal insuff. is Aldosterone synthesis unaffected?

Answer 29

Tertiary

Question 30

Primary adrenal insuff. is associated with which autoimmune syndromes?

Answer 30

polyglandular syndromes

Question 31

Which adrenal insuff. spares the skin and mucosa? and why?

Answer 31

Tertiary and Secondary, because there is a decr in ACTH production –> less MSH by product

Question 32

What is the MC tumor of the adrenal medulla in children?

Answer 32

Neuroblastoma

Question 33

Classic histology presentation of Neuroblastoma:

Answer 33

Homer-Wright rosett and small, round, blue/purple nuclei

Question 34

Name 2 paths derived from neural crest?

Answer 34

Neuroblastoma, Pheochromocytoma

Question 35

Homovanillic acid (HVA) a breakdown product of?

Answer 35

dopamine

Question 36

—- is a breakdown product of norepinephrine.

Answer 36

vanillylmandelic acid (VMA)

Question 37

“dancing eyes-dancing feet” are seen in?

Answer 37

Neuroblastoma, Subacute screlosing P.

Question 38

Name episodic hyperadrenergic symptomsof pheochromocytoma (5 P’s):

Answer 38

Pressure (incr BP)
Pain (headache)
Perspiration
Palpitations (tachycardia)
Pallor

Question 39

T or F? Wilms tumor can cross the midline vs. Neuroblastoma which is smooth and unilateral.

Answer 39

F. its the opposite

Question 40

Why is α-blockade administred in Pheochromocytoma

before giving β-blockers prior to tumor resection?

Answer 40

to avoid a hypertensive crisis.

Question 41

What % causes calcification in pheochromocytoma?

Answer 41

10% calcify

Question 42

Neuroblastoma has an overexpression of which onco-gene?

Answer 42

N-myc oncogene

Question 43

What is a typical histology of Pheochomocytoma?

Answer 43

enlarged pleomorphic nuclei, typical of malignancy.

Question 44

2 tumor markers for Neroblastoma?

Answer 44

Bombesin and neuron-specific enolase ⊕.

Question 45

Name one phath that use Bombesin and neuron-specific enolase as tumor markers?

Answer 45

lung cancer (bronchial carcinoid)

Question 46

3 Paths associated with Pheochomocytoma?

Answer 46

neurofibromatosis type 1,
von Hippel-Lindau disease,
MEN 2A and 2B.

Question 47

Urine and plasma findings is Pheochromocytoma?

Answer 47

 catecholamines and metanephrines in urine and plasma.